Republicans Don’t See Pain, Only ‘Suffering’

There are, according to Representative Mo Brooks (R-AL), people
who have lived “good lives”; Americans who have “done things
the right way,” and have kept “their bodies healthy.” Those
citizens, Brooks said in a CNN interview,
deserve a reward for their good health; they deserve to have
their health care costs reduced, they deserve to have Obamacare
repealed and replaced.

Brooks’s comments, made nearly two months ago, typify the
Republican response to criticisms of both the House and Senate
versions of their health care bill. An image of health has
accumulated in the Republican push to repeal Obamacare, one
that is steeped in a particular fiction of morality. It’s an
image of good Americans who have kept illness at bay, not
because of good fortune or geography or genetics or any of
those fickle things that determine one’s health, but because
they have lived their lives well. That image, that picture of
health, exists in contrast to an image of illness. In these two
separate fictions, the reality of illness—particularly the
materiality of pain—has been rendered virtually invisible,
replaced instead with metaphors that treat the expression of
individual pain as suspect. Illness remains inexpressible even
as the health of the state becomes central to the composition.

Though Senate Majority Leader Mitch McConnell (R-KY) announced on Tuesday that he
would delay the vote on Republican health care bill until after
the July 4 recess, like its House version the bill is sure to
have a second life, as is broader health care debate.

Republican lawmakers rely upon a stereotype of the sick or the
disabled as irresponsible, citizens who have laid waste to
their health through irresponsible decisions. Vice President
Mike Pence implied such waste when he
called for replacing Obamacare with a “system based on personal
responsibility.” The “free market and state-based reform” Pence
said, would correct the irresponsibility plaguing the market;
ostensibly illness itself.

Or, perhaps, Kellyanne Conway expressed that concept more
clearly when, during an interview with
ABC’s This Week, said that the expansion of Medicaid
under the Affordable Care Act was too friendly “to able-bodied
Americans.” “If they are able-bodied and they want to work,
then they’ll have employer-sponsored benefits like you and I
do,” Conway said when asked about the estimated thousands who
will lose their Medicaid coverage.

In his comments, Brooks eventually added that there are some
who have “pre-existing conditions through no fault of their
own.” But the authentically sick are the rare minority, such
comments imply. Instead, good and healthy Americans, those who
have practiced moderation in all things,
are being taken advantage of by those who feign illness,
emboldened as they are by legislation that shuns the free
market (itself emblematic of inherent good), thus rewarding
laziness. Pain might but real—indeed, some people might be in
pain—but its expression remains suspect.

Coding illness as a character flaw isn’t particularly original,
nor is it specific to Republicans in this political moment. The
forced invisibility of the ill, the pretense that the
articulation of pain isn’t somehow political, likely pre-dates
the invention of modern medicine. What Susan Sontag oncecalled the two “kingdoms” of
the “well” and the “sick,” are ancient, constructed with
metaphorical border walls whose foundations are formed deep in
our political core. These two kingdoms are increasingly central
to the American idea of health care, hinting at what
Republicans have recently made explicit: simply, that most
citizens of the kingdom of the sick deserve to be there.

Though, as Sontag writes, every person “holds dual citizenship”
in both kingdoms, the treatment of illness along moral lines
allows us to believe that the kingdom of the well can be
isolated, that it’s morally superior citizens will experience
illness as a singular moment of tragedy, not a lifetime
occurrence. There is no poverty in this rendering, it is a
picture free of anyone who stumbles financially on the often
long path to death; no one who is unable to face the staggering
costs of a child who will require a lifetime of care; no one
who is unprepared to meet the challenges of the free market.
There is “nobody,” according to Representative
Raul Labrador (R-ID), who “dies because they don’t have access
to health care.”

The kingdom of the well is a utopia of sorts—no poverty, no
pain, no accumulation of costs from
chronic health problems. But it is, apparently, deeply
unstable place, constantly teetering on the brink of disaster.
“Every moment Obamacare survives is another day America
suffers,” Pence said. Pence’s words are telling, couched as
they are in a series of medical metaphors, also suspended
between survival and suffering. Here, pain is located both
abstractly and geographically, within the principles of the
state rather than in flesh and blood people; America “suffers,”
while the pain of Americans is unspoken.

The disease metaphor is inherent to politics and its usage
precedes political persuasion. The diseased body of the state,
one that requires a heroic and perhaps violent act of
intervention in order to be saved or resuscitated is a near
constant of modernity. In Illness as a Metaphor,
Sontag cites examples of such imagery employed everyone from
John Adams to French Revolutionaries, Bolsheviks to Nazis and
in the Nixon White House. Pence is just another addition to a
long tradition.

“The melodrama tics of the disease metaphor in modern political
discourse assume a punitive notion: of the disease not as a
punishment but as a sign of evil, something to be punished,”Sontag wrote. Within the
healthcare debate, the disease metaphor spreads from state to
citizens, acting like a contagion. The suffering of the state
is a failure of morality; whatever ails it (Obamacare) will
inevitably infect the citizens who have otherwise lived good
lives.

But then, fear of contagion is part and parcel of the current
Republican ethos, particularly as exemplified by Donald Trump.
Think of the increasingly long list of people who are
contagious, of bodies that can infect the state: undocumented
workers, “radical Islamic terrorists,” the poor, the haters and
losers, black and Latino teens,
protesters, snowflakes, hysterics, and an entire political party who
are “not even people.” Perhaps
that’s why while still on the campaign trail, Trump employed
the disease metaphor, promising to make America great again, as
Pence said, relieve the nation from its suffering. The Trump
rhetoric promises to do so through quarantine, to “build that
wall” or “lock her up,” to seal off the kingdom from those who
bring disease and inflict suffering upon the state. Walls can
be built and travel bans issued, but borders are porous and
they cannot isolate the state from its own citizens. Instead,
metaphors suffice, easily preserving the ideal body that
visibly haunts the Trump worldview, transforming the rest into
an image of disease and deceit, into something to be punished.

That a particular section of the Trump right is dedicated to
the preservation of an ideal white body is
indisputable. Trump himself has often conjured up virility and
masculinity as evidence of potent health, painting his
opposition in the broad strokes of disability or femininity:
“Leakers” undermine his
presidency as people of color threaten to undermine the
security of the country. The boundaries of the health care
debate are an extension of this kind of rhetoric, a kind of
border wall in and of itself that promises to quarantine from
the sick and disabled. The kingdom of the well is not only
wealthy and healthy but it is also implicitly white. While this
is implicit it is rarely made explicit.

To simply mock the disabled as Trump did in
August 2016 invites criticism that’s nearly impossible to
combat, such animosity chafes at common decency, but to turn
disability or illness into something that is morally suspect,
to place it into the same category as criminality, that’s just
politics as usual.

Democrats have responded to the Senate Republicans’ plan, the
Better Care Reconciliation Act (BCRA) by calling it “mean.”
That description, first offered by Donald Trump to describe the
House version of the bill, has been echoed on social media. In
a nearly 1,000 word Facebook
post, former President Barack Obama wrote of the “fundamental
meanness at the core of this legislation,” adding that the BCRA
is “not a health care bill” but “a massive transfer of wealth
from middle-class and poor families to the richest people in
America.” Nancy Pelosi had offered a similar assessment
immediately after Republican leadership finally released a draft of the bill last week.
Pelosi described it as a “tax bill disguised as a health care
bill.” Those two talking points solidified, Democrats have
repeated them relentlessly.

The BCRA is mean, I suppose, but meanness doesn’t quite capture
that worldview that produced such legislation. Meanness sounds
too petty, too much like a schoolyard taunt; it doesn’t quite
capture the deliberate punishment of others for whom, this
worldview implies, such treatment is simply a forcible return
to the natural way of things. To call it cruel seems like an
understatement. The infliction of pain on others while
simultaneously denying the real physicality of that pain seems
beyond cruelty. The irony is that Republicans contend that they
are concerned with suffering, at least in the abstract.

Even as the BCRA will, according to the Congressional Budget
Office, leave 22 million more uninsured, it will reduce the
deficit, it will offer a financial reward to those Americans
who have “done things the right way.” There is a conflation
here with financial inconvenience with the pain of illness or
disability, a constant suggestion that freedom exists as a
financial metric, boxes ticked on IRS form, as though wealth
absolves you from reconciling personal comfort with the lives
of others. Politically and historically, I suppose it
does—wealth and power have never much concerned themselves with
anything but their own preservation, regardless of the
repercussions for others.

That seems particularly true within the health care debate
where rising costs and high drug prices exist within the
narrative of “policy”—a word that conjures up with unconvincing
intellectual pretense wonks like Paul Ryan while simultaneously
taking for granted the pervasiveness of the disease metaphor.
It’s a pretense that allows healthcare to live in the tick-tock
of the news cycle, to remain embedded within the expectation of respectful
political speech, all the while rendering the reality of
illness invisible. Take, for example, Senator Orrin Hatch’s
response to Bernie Sanders. “Let us be clear and this is not
trying to be overly dramatic,” Sanders tweeted. “Thousands of
people will die if the Republican health care bill becomes
law.”

“The brief time when we were *not* accusing those we disagree
with was nice while it lasted,” Hatch responded.

Image via Twitter.

Here, death becomes unspeakable, pain invisible, and respect
necessary. The glib exchange is a potent reminder that the
expression of pain, as Elaine Scarry wrote, “is
bound up with the problem of power.”

The disease metaphor is pervasive, it creates dueling images of
both the sick and the healthy, treating both as natural,
writing them into a perception of the health of a nation. The
image replaces reality, replacing real people—real disease and
disability—with abstraction. Even as it has become a standard
expectation for Americans to publicly share their health
stories, to repeat harrowing details of sick children, to bring
those children to Capitol Hill, to stage die-ins, and to
narrate pain and trauma and stress, those personal stories are
consumed, turned into something suspicious and
criminal.

To speak of death, or to speak of pain is to be suspect, to use
“inflammatory language” or be
labeled dramatic. And yet the consequences for speaking of
neither are even higher. Instead, death and life are forced to
exist in most abstract terms—as a political philosophy or
policy or simple disagreement rather than toward the
articulation of pain. “That’s the Republican way. That’s the
American way,” Pence said.